Dr. Sanjay Shetty began his career in healthcare by choosing medicine over business, but he has long held on to the desire to make healthcare make economic sense. Healthcare doesn’t operate in a traditional market or follow the typical rules of supply and demand, and incentives don’t line up like Econ 101 says they should.
Dallas-based Shetty is on a mission to bring proper incentives back to healthcare and has held leadership roles with significant providers who prioritize value-based care. This March, he transitioned from President at Steward Health Care to President of CenterWell at Humana, the insurer’s healthcare services brand.
Shetty is a board certified radiologist, but now joins a health insurance behemoth that, like most other insurers, is also quickly moving into the provider space. According to Fortune, Humana serves tens of millions of customers nationwide and is ranked No. 41 on the Fortune 500 list. The insurance company has over 67,000 employees and pays special attention to growing its Medicare Advantage business. According to Forbes, Humana has made $3.1 billion this year on $95.6 billion in revenue.
CenterWell Primary Care launched in 2021, and the brand’s pharmacy and home health services branches soon followed. CenterWell Primary Care will have 10 locations in Dallas-Fort Worth by the end of the year (including its 250th location in the RedBird development). Along with its sister brand Conviva Care Center, it is the nation’s largest senior-focused primary care organization, with 250 centers in 12 states serving 266,000 patients. The home health arm is the nation’s largest home health provider, with 350 locations in 38 states, and its pharmacy brands serve nearly three million people.
But the size and reach aren’t what pulled Shetty away from a hospital operator and into the senior-focused primary care world. CenterWell allows him to continue to exist in the value-based space, where providers are incentivized to do the right thing, not more things. But now, his work will target patients upstream before they end up in hospitals. “CenterWell is value-based care at scale,” he says. “And it is a patient population that benefits from those provider incentives. We are thinking about patients 365 days a year.”
Shetty is the first president of the primary care, pharmacy, and home health sectors of CenterWell’s business, as they were recently brought under the same umbrella. He says that integration allows providers to coordinate care even more efficiently. The primary care physician is the captain of the integrated care team that includes nurse practitioners, social workers, pharmacists, community health workers, and home health providers, who all work together to serve the patient.
“Everyone is thinking about the patient, and now we can reach into the home after they have been discharged,” Shetty says. “Caregivers can check on medications and other conditions to ensure they are not ending up in the hospital again.”
With the Centers for Medicare and Medicaid Services looking to expand value-based care for the 65 million people with a Medicare plan, CenterWell is well-positioned to continue to grow. Medicare Advantage plans, and accountable care organizations working in shared savings programs are other forces on the growth of the value-based model.
Despite being owned by a insurance company, Shetty says CenterWell is payer agnostic, working with all insurers to drive more value-based in the primary care, pharmacy, and home health space no matter who is funding it.
In addition to moving into primary care, Shetty is excited about the potential for increased home health care as technology improves to allow higher acuity patients to be cared for in the comfort of their homes. “It aligns with patient hopes and also aligns with the value-based paradigm,” he says. “We work with the patient’s local primary care office and are part of one team to provide quick interventions and ensure they are getting the care they need.”
Equity and wrap-around services were other big draws for Shetty to move into the primary care space with CenterWell and Humana. CenterWell aims to open 450 locations by 2025 (via new locations and consolidation), expanding into areas that lack access to primary care, often opening in retail settings close to where people live. Additionally, Shetty is passionate about offering services that address the social determinants of health for patients via the integrated care offered by primary care centers.
“The most important thing we need to transform healthcare for seniors in the US is to go back to thinking about the patient again,” Shetty says. “It’s so exciting to have the system work better for seniors. We are going after problems and navigating a difficult system, but I have loved the role so far.”
Author
